RACHEAL NINSIIMA
KAMPALA – When it comes to getting infected with dental caries, commonly known as tooth decay, people living with HIV (PLHIV) are greatly affected, a recent study reveals. The study, ‘Prevalence and factors associated with dental caries in patients attending an HIV care clinic in Uganda’, reported that eight in every 10 HIV-infected individuals receiving antiretroviral treatment (ART) had dental caries. This research was conducted among 748 participants aged 18 to 72 attending the Mulago Immune Suppression Syndrome (ISS) clinic.
Dental caries is a progressive infectious disease which, without treatment, eventually leads to tooth loss. The 2017 Global Burden of Disease cites untreated dental caries in permanent teeth as the commonest health condition, affecting all ages of life.
According to Dr Dunstan Kalanzi, the lead researcher, PLHIV had more dental caries when compared to findings from another study that looked at the general population. This may be because the medications they are taking, or even HIV itself, cause decreased salivary flow or a dry mouth, which leads to the development of caries.
“Saliva acts as a buffer to the acid that is produced when oral bacteria breakdown sugars in the foods we eat. Therefore, the change in the quantity and quality of saliva means that tooth surfaces are exposed to the acid for longer periods, making them structurally weak and susceptible to further bacterial invasion, responsible for the onset of caries,” he explains.
This tooth decay frequently develops at the neck of the tooth, where the crown meets the root. This part of the tooth is made up of a bony substance called cementum, which is not as strong as the enamel and more susceptible to decay. Fortunately, decreased saliva flow can be managed through simple measures such as using artificial saliva substitutes, chewing sugar-free gum, drinking water frequently, and avoiding certain medications.
Dr Kalanzi notes that dental caries have negative consequences on the health and quality of life of PLHIV primarily by causing pain, difficulty in chewing food.
“On the extreme end, dental infections can lead to the development of bacterial endocarditis (inflammation of the lining of the heart muscle and its valves) and Ludwig’s angina (skin infection that occurs on the floor of the mouth),” he explains.
In one case, he observed a 52-year-old HIV patient who had been receiving ART for four years having several missing teeth. When she first presented at the prosthetics clinic in 2017, she had extensive tooth decay that left her with just four teeth. She had been taking Tenofovir, Lamivudine and Efavirenz since 2014 and cotrimoxazole prophylaxis (recommended standard of care for opportunistic infections in patients with severe HIV) since 2004. The patient reported that she suffered severe caries from the time she started her HIV treatment although she had lost some teeth before that.
“This case and others we have seen demonstrate that some people living with HIV may be susceptible to extensive caries that is related to HIV and ART. However, there is need for well-characterized studies to understand HIV and ART-related and unrelated dental caries to inform targeted prevention and care interventions,” Dr Kalanzi notes.
PREVENTION RECOMMENDATIONS
Owing to the possible increased risk of tooth decay, it is important for PLHIV to take care of their teeth. Basic guidelines for good oral health suggest that one: brush with a fluoride containing toothpaste twice a day; avoid snacking in between meals; chewing sugar-free gum, preferably after meals and have a dental check-up and cleaning at least once a year.
Nationally, there is a need to integrate oral health into HIV care by providing dental services at HIV care clinics and to train nurses and other health professions involved in HIV care to administer preventive interventions such as topical fluoride varnish.
